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(together with its employees, apprentices of"MLEdyille tat2 Studio") I confirm the following by initialing each applicable item. All questions about the Body Art work have been answered to my satisfaction, and I have been given written and verbal aftercare instructions for the Body Art work I am about to receive. The Body Art has been described or shown to me and is correctly placed or drawn to my specifications. I understand that tattooing is permanent and that if I choose to have it removed. it may, be expensive and leave scars. I am the person on the legal ID presented as proof that I am at least 18 years of age- and in the case of a minor receiving legal piercing, I am the legal parent or guardian of the minor receiving the legal piercing and I am granting permission for this minor to receive the legal body piercing. _I am not under the influence of alcohol or drugs and that I am voluntarily submitting to Body Art work without duress or coercion. Inks we use are not FDA approved and health consequences are still unknown. I understand there is a possibility of an allergic reaction. I understand there is a possibility of getting an infection. I agree to follow all instructions concerning the care of my Body Art work, and that any touch-ups or repairs that may become needed due to my own negligence will be done at my own expense. I understand that there is a chance I might feel lightheaded or dizzy during or after Body Art work. I agree to immediately notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure. Iq have been fully informed of the risks of Body Art including, But, not limited to infection,scarring difficulties in detecting melanoma,and allergic reactions to pigments, latex gloves, and antibiotics. Having been informed of the potential risks associated with obtaining Body Art, I still wish to proceed with the Body Art work and I assume any and all risks that may arise from the Body Art work. If while in facility. I faint or get hurt we are not responsible. Signed Date TATTOO PLACEMENTAND DESCRIPTION MEDICAL QUESTIONIRE (Y/N)Allergic reaction to latex (Y/N)Allergic reaction to antibiotics (Y/N) History of hemophilia or other bleeding disease (Y/N) History of cardiac valve disease (Y/N)Requirements for antibiotics prior to dental or surgery procedures (Y/N)Other risk factors for blood borne pathogen AFTERCARE INSTRUCTIONS CLIENT NAME: _ The following verbal and/or written instructions were communicated to the client: 1. Information on the care of the procedure site. 2. Restrictions on physical activities such as bathing, recreational water activities, gardening, or contact with animals,and the duration of the restrictions. 3. Signs and symptoms of infection including but not limited to redness_swelling,tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site. 4. Instructions to call a physician if any of the addressed signs and symptoms appear or for any other reason related to the Body Art procedure(s). 5. If physician care is required by the client related to the Body Art procedure(s), the client is to notify the Body Art facility and practitioner of the problem and the resolution by a physician or clinic.This information shall be placed in the client's tile. 6. Clean area serval times a day, wash hands before applying ointment A&D or Aquaphor. To the best of my knowledge this information is correct: Practitioner Signature: Date:_ I have received aftercare instructions: Client Signature: Date: 2